Lower Your Sexual Risk of HIV

How Can I Reduce My Risk Of Getting HIV Through Sexual Contact?

In the United States, HIV is mainly spread by having sex with someone who has HIV. There are several steps you can take to reduce your risk of getting HIV through sexual contact, and the more of these actions you take, the safer you can be. These actions include:

Choose less risky sexual behaviors. Oral sex is much less risky than anal or vaginal sex. Anal sex is the highest-risk sexual activity for HIV transmission. If you are HIV-negative, insertive anal sex (“topping”) is less risky for getting HIV than receptive anal sex (“bottoming”). Remember: HIV can be sexually transmitted via blood, semen (cum), pre-seminal fluid (pre-cum), rectal fluid, and vaginal fluid. Sexual activities that do not involve the potential exchange of these bodily fluids (e.g. touching) carry no risk for getting HIV. For more details, see Sexual Practices and HIV Risk, below.

Use condoms consistently and correctly. When used consistently and correctly, condoms are highly effective in preventing HIV. For more details, see Using Condoms, below.

Reduce the number of people you have sex with. The number of sex partners you have affects your HIV risk. The more partners you have, the more likely you are to have a partner with HIV whose viral load is not suppressed or to have a sex partner with a sexually transmitted disease. Both of these factors can increase the risk of HIV transmission. Remember: one in six people living with HIV in the U.S. are unaware of their infection.

Talk to your doctor about pre-exposure prophylaxis (PrEP). PrEP is taking HIV medicine daily to prevent HIV infection. PrEP should be considered if you are HIV-negative and in an ongoing sexual relationship with an HIV-positive partner. PrEP also should be considered if you are HIV-negative and have had a sexually transmitted disease (STD) or any anal sex (receptive or insertive) with a male partner without condoms in the past six months and are not in an exclusive relationship with a recently tested, HIV-negative partner. For more information, see our page on PrEP.

Talk to your doctor right away (within 3 days) about post-exposure prophylaxis (PEP) if you have a possible exposure to HIV. An example of a possible exposure is if you have anal or vaginal sex without a condom with someone who is or may be HIV-positive, and you are HIV-negative and not taking PrEP. Your chance of exposure to HIV is lower if your HIV-positive partner is taking antiretroviral therapy (ART) consistently and correctly, especially if his/her viral load is undetectable. Starting PEP immediately and taking it daily for 4 weeks reduces your chance of getting HIV. For more information, see our page on PEP.

Get tested and treated for other sexually transmitted diseases (STDs) and encourage your partners to do the same. If you are sexually active, get tested at least once a year. STDs can have long-term health consequences. They can also increase your chance of getting HIV or transmitting it to others. Find an STD testing site.

If your partner is HIV-positive, encourage your partner to get and stay on treatment. ART reduces the amount of HIV virus (viral load) in blood and body fluids. If taken consistently and correctly, ART can keep people with HIV healthy for many years, and greatly reduce their chance of transmitting HIV to sex partners.

Of course, you can also reduce your risk of getting HIV by not having sex. If you aren't having sexual contact, you are 100% protected from getting HIV in that way. Alternatively, if you are having sex, you can reduce your risk if you and your partner have both been tested and know that you are both HIV-negative and you practice monogamy. Being monogamous means: 1) You are in a sexual relationship with only one person and 2) Both of you are having sex only with each other. However, monogamy won't protect you completely unless you know for sure that both you and your partner are not infected with HIV.

Sexual Practices And HIV Risk

The risk of getting HIV through sexual contact varies widely depending on the type of sexual activity. Some activities carry a much higher risk of HIV transmission than others.

Your risk depends on several other factors as well, including whether you and your partner are using a condom and—if one of you is HIV-positive—whether the partner who is HIV-positive is using ART consistently and correctly and has achieved a suppressed viral load, and whether the partner who is HIV-negative is using PrEP consistently and correctly. Condoms and HIV medicines can greatly lower the risk of transmitting HIV. For more information, see CDC’s HIV Transmission Risk.

Here is a list of some sexual practices, the risks they pose for transmitting HIV, and steps you can take to lower your risk of getting HIV:

Receptive Anal Sex (Bottoming)

The risk of getting HIV from receiving anal sex (penis in the anus or “bottoming”) without a condom is higher than any other sexual activity.

The partner receiving anal sex (bottom) is at greater risk of getting HIV than the partner performing anal sex (top) because the lining of the rectum is thin and may allow HIV to enter the body.

HIV can found in the blood, semen (cum), pre-seminal fluid (pre-cum), or rectal fluid of a person infected with the virus, so having your partner pull out before he ejaculates (cums) may not decrease your risk.

Do not douche before anal sex. Douching irritates the lining of your rectum and this can increase your risk for getting HIV. If you are concerned about cleanliness, clean the rectum gently, with a soapy finger and water.

If you are bottoming, always use a new condom with a water-based lubricant. This will help minimize damage to your rectum during sex and lower your risk of getting HIV and other STDs.

Insertive Anal Sex (Topping)

Insertive anal sex (penis in the anus of either a man or a woman or “topping”) without a condom is considered a high-risk behavior for HIV transmission, but the risk is not as high as receptive anal sex (bottoming).

The partner receiving anal sex (bottom) is at greater risk of getting HIV than the partner performing anal sex (top), however the top is also at risk because HIV can enter through the opening of the penis or through small cuts, abrasions, or open sores on the penis.

If you are topping, always use a new condom with a water-based lubricant. This will help lower your risk of getting HIV and other STDs.

Receptive Vaginal Sex (Risks For Women)

Receptive vaginal sex (penis in the vagina) without a condom is considered a high-risk behavior for HIV transmission.

In women, HIV can be directly absorbed through the mucous membranes that line the vagina and cervix. The lining of the vagina can also sometimes tear and possibly allow HIV to enter the body.

Your risk of HIV infection increases if you or your partner also has an STD.

You can lower your risk of getting HIV and other STDs by always using a new condom.

Oral or hormonal contraceptives (e.g., birth control pills) do not protect women against HIV or other STDs.

Many barrier methods used to prevent pregnancy (e.g., diaphragm, cervical cap) do not protect against HIV or other STDs because they still allow infected semen (cum) to come in contact with the lining of the vagina. If you use one of these methods, be sure to also use a male condom correctly every time you have vaginal sex.

When worn in the vagina, female condoms are just as effective as male condoms at preventing STDs, HIV, and pregnancy. Don't use a male condom and a female condom at the same time; they do not work together and could break. For information on how to use a female condom, visit the Office on Women’s Health’s HIV Prevention: Practice Safer Sex.

Don’t use nonoxynol-9 (N-9). Some contraceptives, like condoms, suppositories, foams, and gels contain the spermicide N-9. Don’t use these gels, foams, or suppositories to prevent against HIV — these methods only lower your chances of pregnancy, not of getting HIV and other STDs. N-9 actually makes your risk of HIV infection higher, because it can irritate the vagina, which might make it easier for HIV to get into your body.

Don't douche before sex. Douching removes some of the normal bacteria in the vagina that protects you from infection. This can increase your risk of getting HIV.

Insertive Vaginal Sex (Risks For Men)

Insertive vaginal sex (penis in the vagina) without a condom is considered a high-risk behavior for HIV transmission, but it is less risky for the male partner than the female partner.

In men, HIV can enter the body through the urethra (the opening at the tip of the penis) or through small cuts or open sores on the penis. Men who are not circumcised are at greater risk of HIV infection through vaginal sex than are circumcised men.

Your risk of HIV infection increases if you or your partner also has an STD.

Use a new condom with a water-based lubricant every time you have insertive vaginal sex to prevent STDs, including HIV.

Performing Oral Sex On A Man

The risk of getting HIV by performing oral sex (your mouth on someone’s penis or “fellatio”) is low, but it is not zero risk. It is difficult to measure the exact risk because people who practice oral sex may also practice other forms of sex during the same encounter.

Performing oral sex on an HIV-infected man, with ejaculation in the mouth, is the riskiest type of oral sex activity.

If the man you are performing oral sex on has HIV, his blood, semen, or pre-seminal fluid may contain the virus.

Performing oral sex also puts you at risk for getting other STDs, including herpes.

Your risk of getting HIV or other STDs is reduced if you do not have open sores or cuts in your mouth.

You can reduce your risk of getting HIV and other STDs through oral sex if you avoid having your partner ejaculate (cum) in your mouth, and if you use a condom.

The risk of getting HIV by receiving oral sex (someone’s mouth on your penis or “fellatio”) if you are a man is low, but it is not zero risk. It is difficult to measure the exact risk because people who practice oral sex may also practice other forms of sex during the same encounter.

If the person giving you oral sex has HIV, blood from their mouth may enter your body through the lining of your urethra (the opening at the tip of your penis) or your anus, or through cuts and sores.

Receiving oral sex also puts you at risk of contracting other STDs, including herpes.

Your risk of getting HIV is reduced if you do not have open sores or cuts on your penis.

The risk of getting HIV by performing oral sex on a woman (your mouth on a woman’s genitals or “cunnilingus”) is low, but it is not zero risk. It is difficult to measure the exact risk because people who practice oral sex may also practice other forms of sex during the same encounter.

If the woman you are performing oral sex on has HIV, her vaginal fluid may contain the virus.

Performing oral sex also puts you at risk of contracting other STDs.

There are effective barriers you can use to protect you from contact with your partner's vaginal fluids. These include natural rubber latex sheets, dental dams, or using cut-open nonlubricated condoms between your mouth and your partner’s genitals or rectum. For more information on proper condom and dental dam use, see the U.S. Department of Veterans Affairs' Tips For Using Condoms And Dental Dams.

The risk of getting HIV by receiving oral sex (someone’s mouth on your genitals or “cunnilingus”) if you are a woman is low, but it is not zero risk. It is difficult to measure the exact risk because people who practice oral sex may also practice other forms of sex during the same encounter.

If the person giving you oral sex has HIV, blood from their mouth may enter your body through your vagina, cervix, or anus, or through cuts and sores.

Your risk of HIV is increased if you have genital sores or other STDs.

Receiving oral sex also puts you at risk of getting other STDs, such as herpes, syphilis, gonorrhea, genital warts (human papillomavirus or HPV), intestinal parasites (amebiasis), or hepatitis A or B infection.

There are effective barriers you can use to protect you from contact with your partner's mouth. These include natural rubber latex sheets, dental dams, or using cut-open nonlubricated condoms between your partner’s mouth and your genitals or rectum. For more information on proper condom and dental dam use, see the U.S. Department of Veterans Affairs' Tips For Using Condoms And Dental Dams.

The risk of getting HIV by giving or receiving oral stimulation to the anus (your mouth on someone’s anus, also called “anilingus” or “rimming”) is low, but it is not zero risk.

This kind of sexual contact comes with a high risk of transmitting hepatitis A and B, parasites, and other bacteria to the partner who is doing the rimming. There are effective vaccines that protect against hepatitis A and B and human papillomavirus infections. Talk to your health care provider to see if these are right for you, if you have not already been vaccinated.

You can reduce your risk of getting HIV or other STDs if you use a cut-open unlubricated condom, dental dam, or non-microwaveable plastic wrap over the anus to protect against infection. For more information on proper condom and dental dam use, see the U.S. Department of Veterans Affairs' Tips For Using Condoms And Dental Dams.

Digital Stimulation (Fingering)

There is a very small risk of getting HIV from fingering your partner if you have cuts or sores on your fingers and your partner has cuts or sores in the rectum or vagina. HIV transmission this way is technically possible but unlikely and not well documented.

Use medical-grade gloves and lots of water-based lubricant to eliminate this risk.

Sex Toys

There is a very small risk of getting HIV from sharing sex toys. HIV transmission this way is technically possible, but unlikely and not well documented.

Using sex toys can be a safe practice, as long as you do not share your toys with your partner.

If you share your toy with your partner, use a condom on the toy, if possible, and change the condom before your partner uses it.

Clean your toys with soap and water, or a stronger disinfectant if indicated on the cleaning instructions. It is important to do this after each use!

No-Risk Sexual Activities

These activities carry no risk of HIV transmission:

Non-sexual massage

Casual or dry kissing

Phone sex, cyber sex, sexy talk

Masturbation (without your partner's body fluids)

Frottage—also known as "dry humping" or body-to-body rubbing

You can still contract other STDs, like herpes, HPV, or pubic lice ("crabs") if you have bare skin-to-skin contact with your partner.

Using Condoms

When used consistently and correctly, condoms are highly effective in preventing HIV. They are also effective at preventing STDs transmitted through body fluids, like gonorrhea, chlamydia, and HIV. However, they provide less protection against STDs spread through skin-to-skin contact like human papillomavirus (genital warts), genital herpes, and syphilis.

Taking HIV Medicines To Prevent HIV

As noted above, there are ways to prevent getting HIV by taking some of the medicines used to treat HIV. These methods are PrEP (taking HIV medicine daily to prevent HIV infection) and PEP (taking medicine to prevent HIV after a possible exposure).

Circumcision

Male circumcision reduces the risk that a man will get HIV from an infected female partner, and also lowers the risk of other STDs, penile cancer, and infant urinary tract infection. Studies have not consistently shown that it prevents HIV among men who have sex with men. Circumcision is only partly effective and should be used with other prevention measures. Men who are considering circumcision should weigh its risks and costs against its potential benefits.

Related Topics on AIDS.gov

Frequently Asked Questions

What kinds of sexual activity can transmit HIV?

As noted above, any form of sexual activity where there is a risk of exchanging infected body fluids (blood, semen, pre-seminal fluids, rectal fluids, and vaginal fluids) can transmit HIV. For more information on how the virus is transmitted, see How Do You Get HIV or AIDS?